Provider Demographics
NPI:1437762382
Name:ALLAWAY ANGELS
Entity Type:Organization
Organization Name:ALLAWAY ANGELS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALLYA
Authorized Official - Middle Name:SHARESE
Authorized Official - Last Name:ALLAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-825-5656
Mailing Address - Street 1:805 DEERFIELD CT
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-5483
Mailing Address - Country:US
Mailing Address - Phone:404-825-5656
Mailing Address - Fax:
Practice Address - Street 1:805 DEERFIELD CT
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-5483
Practice Address - Country:US
Practice Address - Phone:404-825-5656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No251G00000XAgenciesHospice Care, Community Based
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities